title: Serum sterols in patients with primary biliary cirrhosis and acute liver failure before and after liver transplantation.
abstract: OBJECTIVE
  Liver diseases modify sterol metabolism. Liver transplantation (LTX) provides a model to evaluate the impact of disease-affected liver on sterol metabolism.
  
  
  METHODS
  We studied serum sterol profiles and their relationships to other biochemical markers in consecutive cholestatic patients with acute liver failure (ALF, n=39) and end-stage primary biliary cirrhosis (PBC, n=67) before and 27d after LTX. Accordingly, we determined serum levels of sterols, bilirubin and prealbumin.
  
  
  RESULTS
  Due to weak cholesterol synthesis of ALF-patients before LTX, their serum levels of cholesterol, lathosterol/cholesterol, cholestanol/cholesterol and lathosterol/campesterol were 18%-41% lower (P<0.05 for each) than in PBC, but ratios of phytosterols to cholesterol were equal. In general, non-cholesterol sterol ratios reflected bilirubin and prealbumin concentrations. Interrelation of surrogate sterols showed that homeostasis of cholesterol metabolism prevailed in lowest cholestanol tertile of ALF-patients consistently, but not in PBC. After LTX, cholesterol levels and lathosterol ratios increased in both groups and phytosterol ratios decreased (P<0.01). Cholestanol decreased profoundly in PBC, but remained 26% higher than in ALF (P<0.05).
  
  
  CONCLUSIONS
  Homeostasis of cholesterol metabolism was maintained only in ALF. Metabolism of phytosterols was equal in study groups. PBC- and ALF-patients have differential patterns in their serum sterols and cholesterol metabolism.
authors.affiliation: Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Katriina
authors.initials: K
authors.lastname: Nikkilä
authors.forename: Markku J
authors.initials: MJ
authors.lastname: Nissinen
authors.forename: Helena
authors.initials: H
authors.lastname: Gylling
authors.forename: Helena
authors.initials: H
authors.lastname: Isoniemi
authors.forename: Tatu A
authors.initials: TA
authors.lastname: Miettinen
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002784:Cholesterol / Q000097:blood; D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000378:metabolism* / Q000601:surgery*; D017114:Liver Failure, Acute / Q000378:metabolism* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010840:Phytosterols / Q000097:blood; D011228:Prealbumin / Q000378:metabolism; D013261:Sterols / Q000097:blood*
chemical_list: D015415:Biomarkers; D010840:Phytosterols; D011228:Prealbumin; D013261:Sterols; C001521:lathosterol; D002784:Cholesterol; D001663:Bilirubin